St. Barnabas Hospital

All Charges

Charge

Type

Price

ZZ COIL/.038 STANDARD/4-3

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569080
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.038 STANDARD/4-3

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569080
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.038 STANDARD/5-5

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569081
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.038 STANDARD/5-5

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569081
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.038 STANDARD/5-8

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569082
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.038 STANDARD/5-8

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569082
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.038 STANDARD/8-10

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569083
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.038 STANDARD/8-10

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569083
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.038 STANDARD/8-12

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569084
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.038 STANDARD/8-12

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569084
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.038 STANDARD/8-15

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569085
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.038 STANDARD/8-15

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569085
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.052 STANDARD/10-15

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569101
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.052 STANDARD/10-15

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569101
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.052 STANDARD/15-15

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569284
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/.052 STANDARD/15-15

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569284
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.052 STANDARD/15-20

Facility OP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569285
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.37
Rate for Payer: Fidelis Medicare Advantage	$97.46
Rate for Payer: Group Health Inc Commercial	$46.41
Rate for Payer: Group Health Inc Medicare	$32.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.33

ZZ COIL/.052 STANDARD/15-20

Facility IP

$92.82

Service Code	HCPCS C1884
Hospital Charge Code	41569285
Hospital Revenue Code	278
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$46.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.41
Rate for Payer: Hamaspik Choice Inc Medicare	$46.41

ZZ COIL/DETACHABLE COIL GUIDE/35

Facility IP

$162.94

Service Code	HCPCS C1884
Hospital Charge Code	41569292
Hospital Revenue Code	278
Min. Negotiated Rate	$81.47
Max. Negotiated Rate	$81.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.47
Rate for Payer: Hamaspik Choice Inc Medicare	$81.47

ZZ COIL/DETACHABLE COIL GUIDE/35

Facility OP

$162.94

Service Code	HCPCS C1884
Hospital Charge Code	41569292
Hospital Revenue Code	278
Min. Negotiated Rate	$57.03
Max. Negotiated Rate	$180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.69
Rate for Payer: Fidelis Medicare Advantage	$171.09
Rate for Payer: Group Health Inc Commercial	$81.47
Rate for Payer: Group Health Inc Medicare	$57.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.47
Rate for Payer: Hamaspik Choice Inc Medicare	$81.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.91

ZZ COIL PUSHER

Facility OP

$309.73

Service Code	HCPCS C1884
Hospital Charge Code	41560058
Hospital Revenue Code	278
Min. Negotiated Rate	$108.41
Max. Negotiated Rate	$325.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.09
Rate for Payer: Fidelis Medicare Advantage	$325.22
Rate for Payer: Group Health Inc Commercial	$154.86
Rate for Payer: Group Health Inc Medicare	$108.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.86
Rate for Payer: Hamaspik Choice Inc Medicare	$154.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.32

ZZ COIL PUSHER

Facility IP

$309.73

Service Code	HCPCS C1884
Hospital Charge Code	41560058
Hospital Revenue Code	278
Min. Negotiated Rate	$154.86
Max. Negotiated Rate	$154.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.86
Rate for Payer: Hamaspik Choice Inc Medicare	$154.86

ZZ COIL PUSHER 16

Facility OP

$309.73

Service Code	HCPCS C1884
Hospital Charge Code	41567159
Hospital Revenue Code	278
Min. Negotiated Rate	$108.41
Max. Negotiated Rate	$325.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.07
Rate for Payer: Aetna Government	$180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.09
Rate for Payer: Fidelis Medicare Advantage	$325.22
Rate for Payer: Group Health Inc Commercial	$154.86
Rate for Payer: Group Health Inc Medicare	$108.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.86
Rate for Payer: Hamaspik Choice Inc Medicare	$154.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.32

ZZ COIL PUSHER 16

Facility IP

$309.73

Service Code	HCPCS C1884
Hospital Charge Code	41567159
Hospital Revenue Code	278
Min. Negotiated Rate	$154.86
Max. Negotiated Rate	$154.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.86
Rate for Payer: Hamaspik Choice Inc Medicare	$154.86

ZZ COLAP TRANSJUG CHOLANG

Facility OP

$733.56

Hospital Charge Code	41567320
Hospital Revenue Code	270
Min. Negotiated Rate	$256.75
Max. Negotiated Rate	$586.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$366.78
Rate for Payer: Aetna Government	$366.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$586.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$498.82
Rate for Payer: Group Health Inc Commercial	$366.78
Rate for Payer: Group Health Inc Medicare	$256.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.78
Rate for Payer: Hamaspik Choice Inc Medicare	$366.78

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